As a veterinary anesthetic, xylazine is administered once for intended effect before surgical procedures. Trade name: Rompun. Credit: Zemxer
In May 2022, a 43-year-old UK man known to be an illicit drug user died of an overdose associated with xylazine. The death is the first due to xylazine in the UK, and marks the official entry of the zombie drug into the country’s drug supply.
Xylazine is a non-opioid sedative, painkiller and muscle relaxant used in veterinary medicine as a tranquilizer for large animals. Due to this, xylazine is easily accessible. Also known as “tranq,” the sedative causes depressed breathing, lower blood pressure and heart rate, unconsciousness and necrosis that may lead to amputation—hence its “zombie drug” nickname.
It has wreaked havoc in the United States for about 5 years since it was first seen in Philadelphia—and now, it seems it has spread beyond North American borders.
“This is a really concerning drug that hasn’t been detected in the UK before. This person was likely to have bought heroin and not known it was laced with xylazine and fentanyl,” said senior author Caroline Copeland, from King’s College London. “The drug is not included in standard drug screens in the UK, so we don’t know how widespread the xylazine problem is.”
A full external and internal post-mortem examination of the deceased man found no evidence of disease but did identify puncture wounds to the groin. In post-mortem toxicology, eight drugs were found in both the blood and urine, and an additional three in the urine. Of these detected drugs, all but paracetamol have psychoactive properties. The coroner determined the cause of death was acute aspiration pneumonitis, a condition often caused by inhaling toxins. Xylazine was also listed on the deceased death certificate as contributing to his death.
“This is the first evidence of the drug outside North America. The Birmingham toxicology lab who performed the drug screen noticed a strange peak in the test results that they were able to identify as xylazine,” said lead author Kirsten Rock from King’s College London. “Indeed, it is only down to the vigilance of the toxicologist to notice and report on this strange peak that this was noticed at all.”
Heavy uptick in ketamine
Meanwhile, in the U.S., a new analysis found a 349% rise in seizures of illicit ketamine by drug enforcement from 2017 through 2022.
The study authors say their findings suggest the rising use of ketamine—a short-acting dissociative anesthetic commonly prescribed off-label to treat chronic pain and depression—can increase the likelihood that people who use recreationally or who use inadvertently may encounter an adulterated and potentially harmful version of the drug.
“Unlike illegal ketamine years ago, most illegally obtained ketamine today is not pharmaceutical-grade and is sold in powder form, which may increase the risk that it contains other drugs such as fentanyl,” said study author Joseph Palamar, an associate professor at NYU Langone Health and a researcher in the Center for Drug Use and HIV/HCV Research.
In the study, published in JAMA Psychiatry, Palamar and colleagues found that the total weight of ketamine seized in the U.S. increased from 127 pounds in 2017 to about 1,550 pounds in 2022—an increase of more than 1,100 percent. The highest numbers of seizures were reported in Tennessee, Florida and California, but it is unclear if these states have the highest usage since the location of seizures does not necessarily reflect the final destination of the drug shipments.
Palamar says medical promotion of prescription ketamine in recent years may be fueling black market use and availability. The fear is that any and all illegal powder in the U.S. could be contaminated with fentanyl—significantly, and sometimes unknowingly, increasing overdose risk.